Thyroid : official journal of the American Thyroid Association
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Thyroid hormone deficiency affects all tissues of the body, including multiple endocrine changes that alter growth hormone, corticotrophin, glucocorticoids, and gonadal function. Primary hypothyroidism is associated with hypogonadotropic hypogonadism, which is reversible with thyroid hormone replacement therapy. In male children follicle-stimulating hormone (FSH) is elevated and associated with testicular enlargement without virilization. ⋯ Permanent testicular germ cell damage may occur in men treated with high doses of RAI. RAI commonly increases serum concentrations of FSH and LH while reducing inhibin B levels without affecting serum concentrations of testosterone. Thus, radioiodine therapy transiently impairs both germinal and Leydig cell function that usually recover by 18 months posttherapy.
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Thyroid hormone has important effects on the heart and peripheral vascular system. The relationship between thyroid disease states and cardiovascular hemodynamics is well recognized. Diverse clinical situations are associated with low serum triiodothyronine (T3) levels including a number of cardiovascular illnesses. ⋯ Low serum T3 levels resulting from cardiopulmonary bypass can be safely reversed with pharmacologic T3 supplementation. Data have suggested that T3 repletion may improve postoperative hemodynamic performance and lower the incidence of arrythmias. However, beneficial effects on major clinical outcome variables have not yet been conclusively demonstrated, and require future large-scale clinical trials.
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Review Case Reports
Polymyositis-like syndrome in hypothyroidism: review of cases reported over the past twenty-five years.
Polymyositis-like syndrome, with proximal muscle weakness and elevation of muscle enzymes, may be a clinical manifestation of hypothyroidism. To define the clinical, biochemical, electromyographic, and pathologic characteristics of patients with this syndrome, we identified and reviewed by MEDLINE all cases reported in the English literature from January 1, 1975 through December 31, 2000. Thirty-two cases were considered. ⋯ The characteristics of polymyositis-like syndrome in hypothyroidism did not differ from those of nonspecific hypothyroid myopathy. Clinical judgment alone may not be sufficient to suspect and detect these patients. Serum TSH levels should be routinely determined in all patients with muscle weakness or elevation of creatine kinase.
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Hyperthyroidism due to autoimmune Graves' disease is the leading cause of thyrotoxicosis in pregnant women. The peak incidence of the disease is in the second through the fourth decade of life, which encompasses the reproductive years for women. ⋯ Hyperthyroidism associated with pregnancy may pose a challenging diagnostic and therapeutic dilemma. The current review focuses on the discussion of symptomatology and diagnosis of the disease, on therapeutic options available to women presenting with hyperthyroidism during gestation, and on the controversy surrounding maternal and fetal outcome in pregnancies complicated by thyrotoxicosis.